Job Description

OF JOB DUTIES:

Senior Medical Economics Analyst will be responsible for working with Medicare Advantage and DCE membership files to produce panel reports, identify new and termed members, and other Medicare Advantage/DCE membership reporting.

ESSENTIAL JOB FUNCTIONS:

• Consolidates monthly patient rosters from payers and disseminates standardized list to various departments (Value Based, Finance, Market Clinical Operations, etc.).
• Develops monthly process to identify new and termed members and work across multiple data systems to consolidate demographic details.
• Communicates with operational teams to meet their data and reporting needs.
• Tracks business requirements from payers regarding cost reallocations and monitors case outcomes.
• Develops monthly processes and procedures for identifying candidates for potential cost reallocations and completes accompanying forms, if applicable, for payer submission.
• Obtain and analyze data to understand how to continually improve processes, procedures and execution.
• Maintain knowledge of current healthcare trends by reading appropriate literature and attending related conferences and/or seminars.
• Relied upon to apply business knowledge to analytics projects and provide value-added insights to directly impact business outcomes.

KNOWEDGE/SKILLS/ABILTIES:

• Excellent written and verbal communication skills and ability.
• Proficient in Microsoft Office such as Excel, Word, Access, etc.
• Experience in writing SQL queries preferred.
• Experience with using Tableau, Qlikview, or similar software preferred.
• Strong analytical, organizational, and problem-solving skills.
• Experience working with complex data sets across claims, lab, financial, clinical outcomes, and external sources.
• Knowledge of medical data structures including, but not limited to (ICD10, CPT, HCPCS, NDC)
• Knowledge of different reimbursement models (DRG, APC, AWP+, Cost plus, PDGM)

Qualifications

MINIMUM REQUIREMENTS

• Bachelor's degree in Business, Health Care Administration, Mathematics, Finance, Health Informatics, or related field.
• Requires 4+ years of experience; healthcare-related experience preferred.
• Masters in relevant field preferred and can be substituted for 2 years' experience.